Is age-related macular degeneration associated with pinguecula or scleral plaque formation?

PURPOSE: To evaluate whether ocular changes indicating an increased exposure to UV irradiation are associated with the development of age-related macular degeneration (ARMD). METHODS: Using histology, we have investigated a possible association of ocular changes that might be attributed to actinic damage, namely pinguecula and scleral plaque, with findings of both atrophic and disciform ARMD. A total of 74 eyes, could be used for evaluation. RESULTS: Features of ARMD were present in 36 eyes (11 with disciform degeneration and 25 with an atrophic form). A pinguecula was identified in 36 eyes (small in 22 eyes, large in 14 eyes), and a scleral plaque was seen in 5 eyes. While scleral plaque showed an association with ARMD, there was no significant association between pinguecula and ARMD. CONCLUSIONS: Our results support the concept of solar radiation having an effect on the development of ARMD but also indicate that it is a multifactorial disease.

Effects of retinal laser photocoagulation on photoreceptor basic fibroblast growth factor and survival.

PURPOSE: In an unpublished study, the authors found that immunoreactivity for basic fibroblast growth factor (bFGF) is increased in rod photoreceptors adjacent to long-standing laser burns in human diabetic retinas. The goal of this study was to determine whether laser photocoagulation produces a similar increase in photoreceptor bFGF and promotes survival of these cells in dystrophic rodent retinas. METHODS: Threshold (whitening) and subthreshold (nonwhitening) laser burns were made in retinas of normal and Royal College of Surgeons (RCS) rats and normal and rds mice. The retinas were processed for immunocytochemical and morphometric analyses. RESULTS: In nonlasered normal rat and mouse retinas, bFGF immunoreactivity was prominent in the nuclei of Müller cells and astrocytes. Photoreceptors were bFGF negative except for a zone of bFGF-immunoreactive rods near the ora serrata. Some photoreceptors in nonlasered retinas of RCS rats and rds mice became bFGF immunoreactive. After laser treatment, bFGF immunoreactivity was markedly increased in all photoreceptors flanking the threshold burns and within the subthreshold burns in normal and mutant rats and mice. In RCS rat retinas, photoreceptor bFGF immunoreactivity remained elevated within subthreshold burns and flanking the threshold burns, and photoreceptor survival was prolonged. In rds mouse retinas, increased bFGF immunoreactivity in photoreceptors was not sustained and their degeneration was not retarded. CONCLUSIONS: Laser treatment of RCS rat retinas produced a sustained increase in bFGF immunoreactivity in photoreceptors and prolonged their survival, but laser treatment of rds mouse retinas did not have a long-term effect on photoreceptor bFGF immunoreactivity or survival. Although species differences in laser effects on photoreceptor bFGF and survival are apparent, the finding that rods flanking laser burns in human retinas have sustained increases in bFGF immunoreactivity suggests that laser treatment may be useful for prolonging survival of mutant photoreceptors in retinas of patients with retinitis pigmentosa.

Combined ganciclovir and foscarnet in pediatric cytomegalovirus retinitis.

Cytomegalovirus retinitis is the leading cause of blindness in adults and children with acquired immunodeficiency syndrome (AIDS). Although clinical trials on therapy exist for adults, management of cytomegalovirus retinitis in children is not as well-documented. This report describes the clinical course of a 3-year-old child with cytomegalovirus retinitis. After initial failure with single-agent ganciclovir intravenous treatment, early institution of combined treatment with foscarnet and ganciclovir halted progression of the retinitis. This case report highlights the aggressive nature of cytomegalovirus retinitis in children and the consideration of early combined therapy compared to adult patients.

Consumer product-related ocular trauma.

Leading causes of consumer product-related ocular trauma have not been well described. To delineate these causes in a nationally representative sample, data collected by the US Consumer Product Safety Commission (USCPSC) were reviewed. Data were obtained from the National Electronic Injury Surveillance System (NEISS), a national probability sample survey conducted by USCPSC that continuously monitors consumer product-related injuries treated in hospital emergency rooms across the United States. These data formulated the product summary report for the calendar year 1991. The sampling frame for the NEISS consisted of hospitals listed on the Center for Health Statistics Master Inventory File stratified geographically by size of hospital and number of emergency-room visits. During the calendar year 1991, there were a nationally estimated 298,852 consumer product-related eye injuries treated in hospital emergency rooms. Appoximately 500 different products were implicated in these injuries, with the leading cause being contact lenses (hard and soft), accounting for an estimated 26,490 emergency-room visits. This is followed by welding equipment (12,771 visits), hair curlers/curling irons (5946 visits), and workshop power grinders (5476 visits). Consumer products account for a sizable number of ocular injuries requiring treatment in hospital emergency rooms. Research on outcomes and prevention strategies of the injuries is warranted.

Retinal hemorrhage secondary airbag-related ocular trauma.

A case is presented in which a driver, who was wearing a three-point restraint system, was involved in a collision that triggered deployment of the vehicle's driver's-side airbag. The victim complained of blurred vision after the crash and on examination was found to have suffered a retinal hemorrhage in his right eye. Since no other cause could be determined, his injury was considered to be a result of contact with the deploying airbag.

Practice patterns of the office-based ophthalmologist.

Practice patterns of office-based ophthalmologists were characterized using data collected from the National Ambulatory Medical Care Survey (NAMCS) of 1989, a national probability sample survey conducted by the National Center for Health Statistics. The sample includes office visits made between 1989 and 1990 to nonfederally-employed physicians primarily engaged in office-based practice. Over 38 million office-based patient visits documented in the NAMCS were analyzed. Fifty-two percent of patients (20.4 million) were over 65 years old; 90% (34.9 million) were white, with blacks and Asians accounting for 5% (1.9 million) and 3% (1.1 million) of visits, respectively. The leading primary diagnoses and professional activity associated with the visits were cataract/cataract surgery 23% (8.9 million), disorders of refraction 19.5% (7.5 million), and glaucoma 13% (4.9 million). Over 40% (16.1 million) of visits were for visual dysfunction, abnormal appearance, or abnormal sensation. Nearly 33% (12.5 million) were related to either a diagnostic/screening session or some form of treatment. The duration of visits ranged from 6 to 10 minutes (22.9%), 11 to 15 minutes (29.8%), and 31 minutes or longer (6.7%); 74% (28.1 million) of the patients were asked to return for a follow-up visit at a specified time, and 13% to return if needed. The major sources of reimbursement for office visits were Medicare (41%, 15.6 million); Blue Cross/Blue Shield (13%, 5 million); and other commercial insurance (15.5%, 5.8 million).

Radial keratotomy does not affect intraocular pressure.

BACKGROUND: Recent reports have suggested that a secondary effect of radial keratotomy may be a reduction in intraocular pressure (IOP) levels. METHODS: In an effort to study the relationship of radial keratotomy to IOP, we compared the mean IOP from the baseline and follow-up visits during 1 year after surgery of operated versus nonoperated eyes of patients enrolled in the Prospective Evaluation of Radial Keratotomy (PERK) study. To investigate if radial keratotomy had more of an effect on eyes with higher baseline IOPs, the same analysis was performed on a subset (134 patients) who had a baseline IOP of 15 mm Hg or greater. RESULTS: The average baseline IOP for both operated eyes and nonoperated eyes was 14.6 mm Hg. There was no significant difference in mean IOP between operated and nonoperated eyes across all time points (p = .18). Although mean IOP changed over time, it did not clinically differ in operated versus nonoperated eyes at any time point. These findings were similar in the analysis of eyes with higher baseline IOP (15 mm Hg or greater). CONCLUSION: We conclude that the radial keratotomy performed in the PERK study had no effect on IOP within 1 year after surgery.

Arteriovenous crossing patterns in branch retinal vein occlusion. The Eye Disease Case-Control Study Group.

PURPOSE: The study was designed to evaluate the relative anatomic position of the crossing vessels at the site of occlusion in eyes with branch retinal vein occlusion (BRVO). METHODS: Fundus photographs of 106 eyes (104 patients) with recent BRVO from the Eye Disease Case-Control Study were used to examine the relative position of artery and vein at occluded crossings. Three separate comparison groups were formed by identifying corresponding arteriovenous crossings for each occluded crossing in: (1) the ipsilateral but opposite vessel arcade within eyes affected by BRVO; (2) the same quadrant in unaffected eyes of BRVO patients; and (3) the same quadrant in eyes of patients without BRVO, matched by age, sex, and race with the BRVO patients. RESULTS: The site of obstruction of the branch vein was an arteriovenous crossing in all affected eyes. In 99% of eyes with BRVO, the artery was located anterior to the vein at the obstructed site. In the three comparison groups, the artery was anterior to the vein in 62%, 61%, and 54% of the crossings, respectively, yielding statistically significant differences for each group of control crossings compared with BRVO crossings (P < 0.001). CONCLUSION: Finding the vein to be consistently between the more rigid artery and the retina at almost all arteriovenous crossings affected by BRVO suggests a possible role for mechanical obstruction in the pathogenesis of BRVO.

Ocular trauma among major trauma victims in a regional trauma center.

The authors conducted a retrospective review of the medical records of patients entering an adult level I regional trauma unit to ascertain descriptive epidemiologic information about ocular trauma occurring in the midst of major trauma. Over a 6-year period 6313 patients entered our trauma unit with major trauma. Of these, 856 (13.5%) patients had concomitant ocular trauma. Six hundred twenty-eight (73.4%) patients were male and 228 (22.6%) were female. The average age was 37 years with 743 (86.6%) victims aged between 15 and 55 years, 111 (13.0%) over the age of 55 years. Blacks constituted 48.8% of the sample with whites and other races accounting for 45.4% and 5.5%, respectively. Among the specific causes of ocular injury in our survey, motor vehicle crashes accounted for over 52% of the injuries. Assault-related ocular trauma was responsible for approximately 8% of these injuries. Nearly one third of patients had blood alcohol levels exceeding 100 mg/dL. The mean Revised Trauma Score and Injury Severity Score (based upon AIS-1985 severity coding) of the sample were 6.6 and 19.8, respectively.